REGIONAL MEDICAL PROGRAMS BENEFITING PEOPLE AND IMPLEMENTING LOCAL HEALTH SERVICES An evaluative study supported by Department of Health, Education and Welfare funds and conducted by the Public Accountability Reporting Group. PUBLIC ACCOUNTABILITY REPORTING GROUP 305 FEDERAL WAY a P.O. BOX 5796 o BOISE, IDAHO 83705 THE PUBLIC ACCOUNTABILITY REPORTING GROUP (PAR) IS A COOPERATIVE ARRANGEMENT AMONG THE NATION'S RMPS. IT WAS FORMED TO DEVELOP NATIONAL DESCRIPTIVE AND EVALUATIVE INFORMATION ABOUT RMP PROGRAMS. PAR OPERATES IN COOPERATION WITH THF DIVISION OF REGIONAL MEDICAL PROGRAMS AND UNDER THE AUSPICES OF THE COORDINATOR'S EXECUTIVE COMMITTEE. THIS PUBLICATION WAS SUPPORTED BY FUNDS AWARDED FROM THE DEPARTMENT OF HEALTH, EDUCATION AND WELFARE. ITS CONTENTS ARE SOLELY THE RESPONSIBILITY OF THE PUBLIC ACCOUNTABILITY REPORTING GROUP. THE FINDINGS AND CONCLUSIONS DO NOT NECESSARILY REPRESENT THE VIEW OF THE U.S. DEPARTMENT OF HEALTH, EDUCATION AND WELFARE. 12 m - MAY 1974 - J. R. ABSTRACT REGIONAL MEDICAL PROGRAMS: BENEFITING PEOPLE AND IMPLEMENTING LOCAL HEALTH SERVICES More than 9 million people received direct health care services in Regional Medical Program (RMP) activities in 1973. An estimated 12 million additional persons benefited as a direct result of the use of new skills acquired by local health professionals in RMP training programs. Despite a year marked by lack of clarity in health policy at the Federal Administration level and illegal impoundments of Congressional appropriations, the RMPs continued to record substantial accomplishments in expanding and improving local services for people. Other findings of a March, 1974 national survey of the Nation's 53 RMPs revealed that in 1973: ... over 150,000 health professionals received training in quality assurance medical audit programs, new types of health manpower roles (e.g., nurse practitioners, physician assistants and emergency medical technicians) and new skills (e.g., kidney tissue typing and neonatal intensive care). . . . more than 3500 local health care facilities participated in RMP initiated quality assurance medical audit programs designed to improve specific acts of medical care. Programs frequently result also in moderating costs of care. Since July, 1971: . . . the RMPs have initiated almost 2000 major, innovative demonstration projects. Projects were jointly funded by RM Ps ($1 1 0 million) and other organizations ($53 million). ... over 80 per cent of the almost 1 000 RMP projects not designed as It one-time" activities were continued by local financing mechanisms at an annual estimated level of $58 million after RMP funding support was completed. ... RMPs provided majortechnical assistance in ov.er6OOO instances in creating new health services organizations and in securing over $350 million of non-RMP funds: (1) for other health organizations for needed improvements in local health services, and (2) for rapid, locally suitable implementation of new Federal initiatives. RMPs'community-based process is shown to be an effectively functioning model of a Federally supported, largely locally controlled implementing agency which has major impact in strengthening local health care services systems in preparation for meeting increased demands and needs. TABLEOFCONTENTS SUMMARY i 1. BENEFITING PEOPLE 1 RECENT RMP HISTORY 1 Chronology 1 Comment 2 PEOPLE SERVED BY RMP DEMONSTRATION PROJECTS 2 PEOPLESERVEDBYRMPTRAINEDHEALTHPROFESSIONALS 3 PEOPLE BENEFITED BY RMP INITIATED IMPROVEMENTS IN LOCAL HEALTH CARE SYSTEMS 6 Expanded Capability of Health Manpower 6 New Skills of Professionals Improve Health Services 6 New Types of Health Professionals Increase Access to Needed Services 7 PersonsTrainedinTechniquesofQualityofCareAssurance 7 lmprovementinLocalHealthCareServicesbyQualityAssurancePrograms 7 Increased Access to Care: Initiation of Needed Health Services 9 ALLOCATIONSOFRMPRESOURCESINPEOPLESERVICESPROGRAMS 10 More Effective Use of Manpower 1 0 ImprovedAccessibilityandAvailabilityofPrimaryMedicalCare 10 Regionalization of Secondary and Tertiary (Specialized) Care 1 0 QualityofCareAssurance 10 COMMENT 10 11. IMPLEMENTING LOCAL HEALTH SERVICES 1 1 A COMMUNITY-BASED PROCESS 1 1 LocalStructure:RegionalAdvisoryGroups,VolunteerCommifteesandProfessionalStaffs 11 RMP Process Components: Relative Investments DEMONSTRATIONPROJECTS:JOINTFUNDINGANDCONTINUATION 15 Joint Funding 15 Continuation 17 NEWHEALTHORGANIZATIONSANDFORMALCOOPERATIVEARRANGEMENTS 19 EstablishmentofNewHealthServices 19 NewHealthOrganizationsCreated 19 FormalizationofSharingofExistingResources 19 Establishment of New Training Programs 20 DEVELOPMENTOFRESOURCESFORLOCALSERVICESIMPROVEMENTS 23 COMMENT 25 SUMMARY REGIONAL MEDICAL PROGRAMS: BENEFITING PEOPLE AND IMPLEMENTING LOCAL HEALTH SERVICES INTRODUCTION SECTION 1: BENEFITING PEOPLE A March, 1974 survey of the Nation's Despite these diff icult circumstances, More than 127,000 health 53 RMPs revealed that, despite a year the RMPs recorded substantial professionals received training in of Federal Administration confusion accomplishments in 1973 directly new skills (e.g., kidney tissue and illegal impoundments, the RMPs benefiting people. Majorfindings typing, neonatal intensive care) or have continued to make substantial presented in Section I include: as new types of health manpower accomplishments as local ... More than 6.5 million people (e.g., physician assistants, nurse implementing agencies which provide received direct health services practitioners, emergency medical major assistance in developing needed from RMP demonstration projects. technicians). health services for people. ... More than 2.5 million other patients SECTION II: IMPLEMENTING This report of the survey is organized in received services from new types LOCAL HEALTH SERVICES two sections. Section /, "Benefiting of health manpower (e.g., nurse As Federally supported, largely People," presents evidence of RM P practitioners and emergency locally controlled implementing accomplishments in providing health medical services technicians and agencies, RMPs have developed an services for people. Section others) trained in RMP-initiated effective blend of involved, expert and "Implementing Local Health projects. experienced volunteer boards of Services," describes the RMP ... More than 12 million people were directors (Regional Advisory Groups), community-based process, types of served by health professionals committee structures and professional local expenditures, and specific usingnewskills acquired in RMP staffs. RM Ps assist a wide variety of accomplishments related to strengthening local health services programs. local health interests to make locally systems in preparation for meeting ... More than 27,000 providers were suitable improvements in health care increased demands and needs for trained in quality assurance services for people. health services. medical audit programs. Regional Advisory Groups invest RMP The report clearly demonstrates the More than 3,500 local health care resources through a community-based wasteful loss of needed services to facilities participated in initial process which includes two major people as a result of Federal exploration or actual components: (1) Initiation of administration mandates to dismantle implementation of quality demonstration projects (80% of R MP RMPs as well as illegal Administration assurance medical audit awards), and (2) Non-project related impoundments of Congressional programs. community development activities appropriations. (1 2% of RM P awards), such as technical assistance and convening/facilitating. Fl URE B FIGURE A 1972 2 Federal - - - - - - - - - Decline and - - - Funding - - - - - - 1 -1974. Recovery in - Levels. Service to - - - - - - - - - - - - - - People. ------- tJI97Al I LA @ I , I I I I l@ I I I --- % I II I I 11 I - 973 -I- 11 I @l I I I : - - 4 RMPs'administrative costs represent ... Major, specific technical a modest (7-8%) investment of direct assistance to a wide array of local costs of the program. health interests which resulted in RMP accomplishments which are over 6,000 occasions where new directly associated with the health services and supportive community-based process described, organizations or formal since July 1, 1971, include the cooperative arrangements for following: sharing resources were created. COMMENT Joint Funding by other ... Major assistance by RMP program Despite Federal Administration organizations in more than 1,000 staffs in developing over 1,000 vagaries of financing and program demonstration projects provided a applications for non-RMP funds direction, evidence reported indicates total amount of over $50 million in a for other local health organizations that the Nation's RMPs have continued three-year period for projects to support the development of to implement locally-needed, improved which were supported by RMP needed health care systems health services for people. funds in a total amount of $1 1 0 improvements and locally suitable In addition to improving services to million. versions of Federal initiatives. people, the RMPs have developed a ... Continuation of over 80% of ... Major assistance in securing over community-based process which is an RMP-initiated demonstration $350 million in a three-year period effectively functioning model of a projects through regular financing of non-RMP financial resources for federally supported, largely locally mechanisms in local health care other local health organizations to controlled implementing agency, which services systems; the estimated support needed community health has major impact on local health care first year operational cost after systems improvements. services systems. completion of RMP funding support The RMPs remain a major National was over $58 million. resource capable of prudently and effectively assisting local communities to implement expanded health NEEDED services for people. HEALTH SERVICES LOCAL VOLUNTEER DECISIONS SECTION I REGIONAL MEDICAL PROGRAMS: BENEFITING PEOPLE The Nation's RMPs have built a RECENT RMP HISTORY "Phase-out" orders to close down tangible, impressive record in assisting Since January 1973, the Nation's operations were rescinded. However, the orderly development and RMPs have experienced a series of many RMPs had suffered significant implementation of needed health curious events which have had marked disruptions of painstakingly developed services in hundreds of communities impact on services to people. community relationships, as well as and areas across the Nation. Chronology losses of experienced key program This section of the RMP On January 29, 1973, the and project staff. evaluative study provides President's fiscal year 1974 budget A nominal restoration of new RMP documentation of diminished, but message to Congress recommended operations began on July 1, 1973. The continuing accomplishments despite zero funding for RMPS. The budget restoration was marred both by more than a year of Federal narrative contained a j ustif ication continuing Administration administrative health policy which, to many observers, was impoundments of RMP funds and by uncertainty, phase-out directives, and superficial, inaccurate and unclearadministration direction. In one unlawful impoundments of contradictory to previous public instance, $6.9 million of RMP funds Congressional appropriations. statements of Administration were "released" with the stipulation The major focus of Section I is on spokesmen. The "justification" also that the Congressionally appropriated RMP efforts leading to increased and ignored the fact that many of its own funds could not be spent until a "new improved health services for people. It charges (e.g., "no consistent theme in mission" was established forthe RMPs also provides updated information RMP programs") resulted from for the extension year. correlated with a previous evaluative inconsistent and frequently changing Not until September 7, 1973, report.' Federal directives. Despite strong however, did the Administration finally Section I is organized as follows: indications that the Administration's issue a new program mission ... A Chronology of and Comment budget proposal was clearly contrary to ("priorities and options") for the year on Recent RMP History. Congressional intent, on February 7, beginning July 1, 1973. The "priorities ... People Served by RMP 1973, the Administration directed the and options" sharply restricted the Demonstration Projects. RMPs to close down operations by mission of the RMPS, seemed at ... People Served by RMP Trained June 30, 1973. variance with the legislative mandate, Health Professionals. Congressional action to continue the and required that all activities be ... People Benefited by RMP legislative authorization for RMPs completed by June 30,1974. Initiated Improvements in Local Health followed in rapid sequence: Administration intent appeared to be to Care Systems. a. On March 25, 1973, the Senate release RMP funds: (a) at a level ... Allocations of RMP Resources in passed, by a 72-19 vote, a one-year considerably less than the full amount People Services Programs. extension bill. of the Congressional appropriation, ... Comment. b. On May 31, the House of and (b) under time schedules which Representatives passed, by a 372-1 could serve only to hinder the RMPs' vote, a one-year extension. capability to work effectively at the local C. OnJune5,theSenatepassed,by level. a unanimous 94-0 vote, the House amendments to the Senate bill. d. OnJunel8,thePresidentsigned into law (PL 93-45) the bill which extended authorization for the RMP through June 30,1974. Mitchell, J., et al., "The 56 RMPS: A Special Progress Report," Drug Research Reports, Vol. 16, No. 8, February 21, 1973. On September 21, 1973, the period July to December 1973. RMPs PEOPLE SERVED BY RMP National Association of Regional continued to achieve substantial Medical Programs initiated civil action results during this time; however DEMONSTRATION PROJECTS ,only proceedings seeking three actions in a few instances are the results at The RMPs continue to have a major from the Administration: (1) release of levels as high as those achieved in impact in serving personal health care $115 million of impounded RMP funds, 1972 or those approved in 1973 needs of consumers. While RMPs do (2) relief from the restrictive mission operating schedules. not ordinarily provide direct health statement of September 7, 1973 and Based on recorded and forecasted services, there are numerous (3) relaxation of a June 30, 1974 results from operational activities in the instances where direct -often highly termination date which had been set as current six months (January to June technical services are supported as a deadline by which RM Ps must 1974), there is an upward trend toward part of a demonstration project. effectively complete projects. higher levels of services to people. Examples include: (a) person screened On February 7, 1974 a Federal Carry-overof the funds released late in in hypertension screening projects, (b) district court ordered release of $130 1973, plus release of the additional patients treated by project staff of a million of impounded funds to the awards has provided a sufficient demonstration unit for specialized RMPS, removal of the mandatory financial base so that projections are cancer care, or (c) patients seen by a termination date of June 30, 1974, and realistically based on scheduled nurse practitioner or a neighborhood lifting of the restrictive program activities of operations currently in clinic staff supported by an RMP. Table '.priorities and options." effect. I summarizes such direct services Comment Although buffeted in the past year, recorded in RMP demonstration The following summary of RMPs' the RMPs apparently have made projects. accomplishments in developing health substantial, quick recoveries. As local services for people unsurprisingly implementing agencies, they have reflects a consistent pattern of maintained organizational capability as lessened program impact in the past 18 well as noteworthy records of months. The most marked eff ect of the accomplishment in the development of "phase-out" orders is seen in the health services for people. TABLE I* PEOPLE RECEIVING DIRECT HEALTH SERVICES IN RMP DEMONSTRATION PROJECTS: SUMMARY CALENDAR PF OF PROJECT 1970 (56 RMPS) Primary Care 2,622,000 Emergency Medical Services 466,000 Regionalization of secondary and tertiary care 2,715,000 TO 5,803,000 *a. Thecomparisoncitedforl970andl972wasreportedbythe56 RMPs then in operation. There currently exist 53 RMPS, 49 of which responded to this survey. While direct comparisons should be made with caution, major trends are considered valid. b. All numbers are rounded to the nearest thousand. 2 Table II presents further detail about TABLE 11 people directly served in the course of PEOPLE RECEIVING DIRECT HEALTH SERVICES IN RMP RMP demonstration activities. The DEMONSTRATION PROJECTS: DETAIL OF numbers of people who received direct REGIONALIZATION OF SECONDARY AND TERTIARY CARE health services from RMP projects of a PROJECTS categorical type generally decreased between 1972 and 1973. In part, this decrease was due to Federal directives. A general decrease in CALENDAR CALENDAR people served is due in large measure TYPE OF PROJECT 1970 @@@ @ @ 1 972 @ @- (56 RMPS) t56 RMr-a-,' to the decreased level of financial resources available. Sharp upward trends in numbers of Heart Disease 1,126,000 1,086,PgO people served in hypertension projects Cancer 413,000 523,000 '606 reflect fulfillment of previous Stroke 140,000 @48, projections. Kidney 13,000 33@000@@@@ @84@OPO Hypertension 135,000 Pulmonary Disease 300,000 All Other 588,000 11762,000 PEOPLE SERVED BY RMP TRAINED HEALTH PROFESSIONALS TOTALS 2,715,000 4@ The RMP record is well known in accomplishment of the early mission of "bringing advances in medical Health manpower training activities nurse practitioners, nurse midwives, knowledge to the bedside of the of RMPs generally have resulted in (a) community health assistants, and patient," Many physicians and nurses new types of health professionals emergency medical technicians. have been taught new skills for use in trained to meet the changing demands R M Ps h ave al so s u ppo rted the coronary care units; many stroke for health care services, or in (b) the development of new skills in existing rehabilitation teams have been trained; acquisition of new skills by existing health manpower. New skills is an and large numbers of neighborhood health manpower. RMP program categorywhich includes health aides have been trained and New types of health manpower is an organized eff orts aimed at the placed. As a result of RMP health RMP program categorywhich includes acquisition of essentially new skills by manpower training activities, all persons trained in newly defined persons already educated, licensed or substantial numbers of people now categories of health manpower where certified. Examples are: (a) a have ready access to improved health no widespread, nationally recognized registered nurse who becomes a services not previously available. training programs, certification or coronary care unit nurse, and (b) a licensure exist. Examples include physician who develops advanced skills as a neonatal intensive care specialist. TABLE III Table III summarizesthe numbersof people served in the remainder of the PEOPLE SERVED BY RMPs TRAINED HEALTH PROFESSIONALS: year in which training occurred. SUMMARY Numbers include only persons given direct health services during the time CALENDAR period indicated. For example, a "nurse practitioner" trained in late 1972 TYPE OF SERVICE 1970 may have served atotal of 300 patients (56 RMPS) in the remainder of 1972. In actuality, however, the nurse practitioner may Served by new types of have continued to serve increasing health professional numbers of persons in each year since manpower 969,000 the completion of training. However, the cumulative total number of persons Served bv new served is unreported. acciui dbyexisting health professionals 19,383,000 TOTALS 20,352,000 3 Taking into consideration the differences in numbers of RMPs reporting in each of the time periods, the following observations are considered valid: People served by people trained by RMPs increased from about 20 million to over 30 million in the period from 1970 to 1972, an increase of roughly 50%. People served by people trained by RMPs decreased from over 30 million in 1972 to less than 15 million in 1973: a decrease of over 50%. Figure 1 is a graphic portrayal of the sharp decline and beginning recovery of persons served by health providers using newly acquired skills. FIGURE I PEOPLE SERVED BY VARIOUS HEALTH MANPOWER TRAINED IN NEW SKILLS BY RMPs 3.5 3.0 Medical Technicians, Laboratory Tech- nicians and other ui 2.5 Nurses U- 2.0 1.5 1.0 Doctors/ .5 July 1-72 Jan. 1-73 July 1-73 Jan. 1-74 to Dec. 31-72 to June 30-73 to Dec. 31-73 to June 30-74 Figure 2 is a graphic pattern of the recent RMP program emphasis in assisting the training and placement of persons innew types of primary health care roles. RM Ps trained nurse practitioners (563) andphysician assistants (1 63) who provided direct health services to more than 650,000 patients in 1973. An additional 2,000,000 patients received direct health services in 1973 from other typesof new health manpowertrained; for example, emergency medical technicians, kidney tissue typing technicians, nurse midwives, and community health assistants, FIGURE 2 PEOPLE SERVED BY NEW TYPES OF HEALTH MANPOWER 1.5 Legend: For example, 1.4 1.2 million people 1.3 were served. 1.2 LU 1.1 EL C) l'O .9 Emer ency 8 9 Medical Tech- 7 nicians, Community Health Aides & Others 6 .5 Nurse .4 Practitioners .3 .2 Physician Assistants 0 July 1-72 Jan. 1-73 July 1-73 Jan. 1-74 to Dec. 31-72 to June 30-73 to Dec. 31-73 to June 30-74 PEOPLE BENEFITED BY RMP 3. Creation of new health services, INITIATED IMPROVEMENTS IN particularly in underserved areas. LOCAL HEALTH CARE SYSTEMS Expanded Capability of Health Many people have gained easier Manpower. access to higher quality health care As reported earlier, RMPs'training services as a result of RMP activities in efforts have added sizable numbers of local communities. RMP activities new types of health professionals resulting in improvements in local needed to provide local services. health care services are reported in the Training efforts also have resulted in following categories: new skills for large numbers of 1. Expanded capability of the practicing health professionals. A Nation's health manpower; summary of the numbers of health 2. Improvement in local health care professionals trained in new skills or in service through introducing quality of new professional roles is presented in care, medical audit programs; Table IV. TABLE IV NUMBERS OF HEALTH PROFESSIONALS TRAINED BY RMPs LENDAR CALENDAR y OFT NIN 1970 1972 (56 RMJ w s 90@887 120,834 New Skills of Professionals Improve Health Services. Traditionally, RMPs have provided community and have been of benefit to The slight increase in numbers of existing health manpower with ever increasing numbers of health doctors trained result from relative opportunities to acquire new skills services consumers. increases in projects concerned with aimed at providing betterquality care to A summary of the numbers of local hypertension, kidney disease and people served. These activities have health providers trained in essentially other specialized services such as been well received by the health new skills is shown on Table V. neonatal intensive care. TABLE V NUMBERS OF EXISTING HEALTH PROVIDERS TRAINED IN NEW SKILLS BY RMPs CALENDAR CALEN R TYPES OF 1970 1972 HEALTH MANPOWER (56 RMPS) (56 RM Doctors 13,561 16, Nurses 38,159 42@@ Others including Medical, Laboratory and other Tecnnicians, 34,641 48@61 07, 0 TOTALS 86,361 1 o 9 New Types of Health Professionals Increase Access to Needed Services. Increased access to primary care innovative, promising method of services has continued to claim RMPs increasing access to needed health attention and efforts in recent years. care services. A summary of the The development of new types of numbers of new types of health health professionals specifically professionals trained primarily to trained to provide primary health care increase access to primary care is as "mid-level practitioners" working shown in Table VI. closely with physicians has been an TABLE VI NUMBERS OF HEALTH PROFESSIONALS TRAINED IN NEW ROLES BY RMPs CALENDAR CALENDAR TYPES OF 1970 1972 HEALTH MANPOWER (56 RMPS) (56 RMPS) Nurse Practitioners Physician Assistants Community Health Assistants, EMTs and Others L TOTALS 7,526* 13,825* '@ Information is not available by profession for 1970 and 1972. Persons Trained in Improvement in Local Health Techniques of Quality of Care Services by Quality Care Assurance. Assurance Programs. RM Ps have trained numerous health The numbers of persons trained in In this report, quality of care professionals in techniques to assure quality assurance techniques assurance programs are defined as high levels of quality care available to increased almost six-fold between systematic efforts to set standards, patients in local health facilities and 1970 and 1972. RMP program effort in determine deficiencies in individual or clinics. Table Vil summarizes the quality assurance techniques is collective acts of medical care, to numbers of health professionals substantial, though it remains less than develop corrective action, and to trained in quality of care assurance forecast for 1973. implement activities which result in techniques. demonstrably improved quality of care. TABLE Vil NUMBERS OF HEALTH PROFESSIONALS TRAINED IN QUALITY ASSURANCE PROGRAMS CALENDAR CALENDAR NG@ 1970@ 1972 (56 RMPS) (56 RMPS) 6 72 32,394 Quality of care assurance activities Stage 1 -A local need is offer a classic RMP example of an identified and RMP supported effective, local developmental process professional resource persons are which results in sustained change after assembled. Table VI II summarizes the RMP support is withdrawn. numbers of professional resource Program development typically persons leading RMP program followed a three-stage process. developments in quality assurance in each of four time periods. TABLE Vill NUMBERS OF PROFESSIONAL RESOURCE PERSONS INVOLVED IN QUALITY ASSURANCE PROGRAM DEVELOPMENT FISCAL YEAR 1973 FISCAL YEAR 1974 July-Dec. Jan.-June July-Dec. jan.-june Pro sional resource 'persons involved as 818 1,019 "T ers/De iopers@' A sharp recovery in the last period "convening/facilitating" activities to reflects both Federal priority and local begin exploratory development, and/or capability to use released funds; participate in formal projects aimed at however, the increase is not as great developing skills and implementing as the level the RMPs expected to quality assurance mechanisms in their reach in 1973. facilities (e.g., medical audit systems). Stage 2 - Representatives of Table IX summarizes numbers of local health care facilities participate in facilities involved in each type of RMP-sponsored participation. TABLE IX HEALTH CARE FACILITIES INVOLVED IN RMPs'QUALITY ASSURANCE PROGRAM DEVELOPMENT FISCAL YEAR 1973 July-Dec. Jan.-June 524 638 403 545 TOTALS 927 1,183 Stage 3 - As local health care programs (for example, educational facilities identify specific deficiencies in experiences and organizational health care, corrective action is changes) following specifically initiated by health care providers identified deficiencies is presented in involved within the facility. A tabulation Table X. of over 5,000 formal corrective TABLEX FORMAL CORRECTIVE PROGRAMS WITHIN LOCAL HEALTH CARE FACILITIES PARTICIPATING IN RMP QUALITY ASSURANCE PROGRAMS FISCAL YEAR 1973 FISCAL July-Dec. Jan.-June julv-Dec@ Formal Corrective Programs I @tiated bv Local Facil@!t@ 1,307 1,383 Increased Access to Care: Initiation of Needed Health Services. As a consequence of RMP 1,800 new health service units needed New health services organizations in demonstration projects and substantial locally to provide services to people. whose establishment RMPs technical assistance by program staffs, Included, for example, are participated, continue to provide major impetus to the creation of new neighborhood health clinics, rural needed services without continuing health service units needed in local health stations for primary emergency RMP technical or financial assistance. communities has been provided. Since care, formal agreements for Table XI summarizes the types of new July 1, 1971, RMPs have assisted local cooperative sharing of specialized health services created in the course of communities to implement more than services, and ambulatory out-patient RMP projects and program staff clinics in hospitals in underserved efforts. urban areas. TABLE XI NEW HEALTH SERVICES CREATED (Since July 1, 1971) @T of Ne Healt @se y ces p i S6 Pi Ei 1,250 Si rtia 579 TOTAL ALLOCATIONS OF RMP RESOURCES IN PEOPLE SERVICES PROGRAMS The RMPs have allocated their Improved Accessibility and Quality of Care Assurance operating funds into four major Availability of Primary Medical Care programs are an RMP program program areas. Total direct costs includes development of new or category which includes efforts to awards to RMPs are categorized for improved health care services such as assist loca'I hospitals, out-patient three calendar years in the following family health centers, free clinics, departments, and physicians in private program areas. hospital-based ambulatory care practice to perform audits of care and More Effective Use of Manpower centers, primary and emergency care efforts to foster development of is an RMP program category which centers, and improvements in minority standards or other mechanisms includes new skill development, new group access to services. needed to improve care provided. types of manpower development, Regionalization of secondary Relative investments of RMP efforts to implement arrangements for and tertiary (specialized) care resources in the four program areas shared training and service resources includes RMP efforts to facilitate along witb remaining administrative in underserved areas, and efforts to general institutional sharing of scarce costs is shown for three years in Figure bring about improved utilization and resources such as radiation facilities, 3. relevance of health manpower training shared services such as joint program s. purchasing, and development of needed services forspecialized care of heart disease, cancer, stroke and other patients. Emergency Primary Care CALENDAR 1970 (56 RMPS) Medic $11,413,000 t FIGURE 3 Servic ALLOCATIONS OF RMP RESOURCES TO $832,( PEOPLE SERVICE PROGRAMS Effective Manp $24,163,000 (Selected Calendar Years) (32%) zat CALENDAR 1972 (56 RMPS) Primary Care Effective Manpi $4,506,OC $24,790,000 (6%) ooo (29%) CALENDAR 1973 (49 RMPS) Manpow (18%) $17,002, EMS $7,020,217 $87,049,000 (12%) $60,945,685 Figure 3 also reflects the overall 2. Administrative costs have have continued to assist in the decrease in resources available in decreased from an estimated 14% in implementation of locally needed 1973. However, relative investments 1970 to 8% in 1973, in part due to health service programs for people. have remained essentially stable in the increased efficiency of local The RMPs remain a major National three years with the following operations. resource capable of prudently and exceptions: COMMENT effectively assisting local communities 1. The investment in assisting the Despite Federal administration to implement expanded health development of emergency medical vagaries of financing and program services for people. services has increased, due in part to direction, the evidence reported Federal budgetary actions. indicates that the Nation's RMPs SECTION 11 THE REGIONAL MEDICAL PROGRAMS: IMPLEMENTING LOCAL HEALTH SERVICES The Nation's RM Ps constitute a Less widely known are results A COMMUNITY BASED PROCESS major resource for implementing growing out of the RMP process of There are two major components of professional responses to locally working with a wide array of local the community based RMP process: identified health needs within the broad health agencies and organizations. (1) an effective blend of local boards framework of national health policy. As Original legislation creating the RMPs of directors, volunteer committees and currently constituted, RMPs offer an provided a broad mandate to act as an professional staffs; effective model of an implementing implementing agency to develop (2) a locally determined pattern of agency which functions at the local innovative changes through a expenditures which includes level "to convene, coordinate and community-based, locally controlled demonstration projects and community correlate federal, state and local process involving cooperative development activities. government efforts with private arrangements among local health Local Structure: Regional Advisory provider efforts and with others toward professionals and organizations. That Groups, Volunteer Committees improving health care services. "2 process, the communitystructures and and Professional Staffs. Section 11 of this special progress effective working relationships .. RMPsarefederallysupported reportfromtheNation'sRMPsfocuses painstakingly developed constitute a implementing agencies which are primarily on accomplishments in local major strength of RM Ps; they are largely locally controlled. Regional health care systems development. important reasons for RMP Advisory Groups act as boards of RMP accomplishments summarized accomplishments summarized as directors to study and act upon health are those which are directly related to follows: problems in a way that is best suited to the unique role of the RMPs as a ... A Community-Based Process local situations. Volunteers serve long community-based, federally supported ... Demonstration Projects: Joint hours, often at considerable personal implementing agency. Funding and Continuation financial sacrifice. RMPs'impact on development of New Health Organizations and The financial value alone of time needed health services for people is Formal Cooperative Arrangements donated by volunteers in integrating well known and is documented ... Development of Resources for the activities of the RMPs into health elsewhere. Improved services for Local Services Improvements care systems in local areas is truly people result from operational efforts in ... Comment impressive. For example, a detailed the areas of access to primary and analysis conducted by an RMP in the emergency health care, the South conservatively estimated the development of quality of care value of the "man-hours" contributed assurance programs in local health by the Regional Advisory Groups care facilities, development of new volunteers during federal fiscal year skills in existing health manpower, 1973 as $450,000. development of new types of manpower and innovative demonstration clinics and patient care projects. This impact has been uniquely effective and uniquely far reaching. 2' 'A Report from the Coordinators of the Nation's Regional Medical Programs" (mimeographed August 6, 1973). In addition to Regional Advisory major committees whose members necessary to assist communities to Groups, RMPs make use of numerous had volunteered at least one day of develop workable solutions to complex important volunteer committees for service in the preceding six months. health problems. purposes such as technical review and Together, the voluntary groups and Table X I I I shows the cu rrent project development, Table Xii RMP professional staffs provide a local composition of RMP program staffs displays current membership of RMP mechanism which constitutes the wide and staffs of externally operated RMP Regional Advisory Groups and of range of skills, training and experience demonstration projects. TABLE Xii CURRENT RMP VOLUNTEER STRUCTURE (As of February 1, 1974) (49 RMPS) TYPE OF VOLUNTEER ACTIVITY NUMBER OF VOLUNTEERS REGIONAL ADVISORY GROUPS: Doctors (e.g., MDs, DOs, DDS) 8@l RNs, Allied Health 249 Health Administrators 438 Members of the Public 547 TOTAL 2085 MAJOR COMMITTEES: Doctors (e.g., MDs, DOs, DDS) 2175 RNs, Allied Health 1004 Health Administrators 905 Members of the Public 1012 Others - Not Classified 278 TOTAL 5374 TABLE Xill CURRENT RMP STAFF STRUCTURE (As of February 1, 1974) (49 RMPS) TYPE OF STAFF STAFF NUMBER FTE* RMP PROGRAM STAFFS: Doctors (e.g., MDs, DOs, DDS) 72 56 RNs, Allied Health 48 42 Social and Behavioral Scientists 398 378 (e.g., educators, administrators) Support Staff (secretarial & clerical) 295 278 TOTALS 813 754 STAFFS OF RMP DEMONSTRATION PROJECTS: Doctors (e.g., MDs, DOs, DDS) 326, RNs, Allied Health 642 Social and Behavioral Scientists 750 (e.g., educators, administrators) Support Staff (secretarial & clerical) 799 TOTALS 2517 1696 1 *FTE's are full time equivalent staff s, rounded to nearest whole number. The eff ect of a Presidential message By February 1, 1974, both the and subsequent DHEW directives to numbers of committee volunteers and phase-out" RMPs had drastic the numbers of project and program on the numbers of staffs had increased, however repercussions numbers were still at lower levels than volunteers participating in RMP major committees and on both program and they had been prior to the phase-out project staff of RMPS. orders. Figure 4 graphically shows the The recovery of RMP volunteer dramatic drop in membership of structures and staffs toward committee volunteers and staffs. The pre-phaseout levels strongly argues Regional Advisory Groups, however, that the general health community t'naintained considerable membership maintains a continuing commitment to stability. the RMP mission as well as a belief in RMPs'important implementation role in local health care services system. FIGURE 4 RNLP ADVISORY STRUCTURES AND STAFFS: EFFECTS OF FEDERAL ADMINISTRATION PHASE-OUT ORDERS 6500 - 6000 - 5500 - 5000 - 4500 - 4000 - 3500 - 3000 - 2500 - Regional Advisory Groups 2000 - 1500 - O@t 1000 - 500 - 0 Jan. 1, 1973 July 1, 1973 Feb. 1, 1974 RMP Process Components: Relative Investments Funds3 available for use by local organizations to achieve specifically (b) ConveningIFacilitating-9 activities RMPs constitute a valuable community defined objectives; often projects are include RMP efforts to assist local resource for assisting and accelerating co-funded by other local, state and groups, agencies and others to form ad improvements in local health care Federal agencies. Local RMP hoc and persisting cooperative service systems. The RMP processes professional staff s maintain significant, arrangements or agreements and to for investing locally controlled funds frequent contact with operating develop a common local are an important aspect of that projects in activities such as understanding of the implications of resource. inter-project coordination, monitoring, new Federal programs. RM Ps invest their program evaluating, seeking continuation Convening/Facilitating efforts are resources in two basic process funding, and recommending (to directed toward specific results; e.g,, components: Regional Advisory Groups) continuation funding of RMP initiated (1) initiation of demonstration modification of objectives and projects or implementing locally projects, and rebudgeting of project funds which are suitable versions of new, Federal (2) non-project related community not being expended at expected rates. initiatives. development activities, primarily by RMPs also provide other non-project Direct costs associated with local professional staffs. related community development community development activities There are two kinds of functions. The primary components of include both project related and demonstration projects in RMPS: non-project related community non-project related activities. Figure 5 (a) Pilot projects include trial efforts development activities are: shows the relative costs of project or feasibility studies aimed at (a) Technical Assistance activities activities and of non-project community evaluating the potential of the project include consultant and program staff development activities for each of the objectives prior to implementing a time and costs used to fulfill requests last two fiscal years. Direct costs used more substantial project. by local agencies for assistance, for for local administration remain (b) Operating projects are usually example, developing grant minimal, an indication of RMPs' larger scale, externally operated applications for new Federal initiatives. organizational efficiency. demonstration projects based on the Technical assistance essentially is the direct or indirect outcomes of pilot sharing of RMPs staff and volunteer projects. Funds to support operating expertise with all other elements in the projects are awarded by Regional health services system; Advisory Groups to local health FEDERAL FISCAL YEAR FIGURE 5 1974 RMP DIRECT COSTS $58,516,651 EXPENDITURES BY FEDERAL FISCAL YEAR PROCESS COMPONENTS 1973 Projects (49 RMPS) $74,361,108 ing" Projects 866,918 .8% Demonstration Projects (a) "Operating" Projects $49,172,931 66.0% Ad Communi 00 14.. Developmei $5,529,35 bA 9.51/c Administi Community Development $6,112,7 $8,263,553 8.2% 11.4% 3AII dollar figures in this report are based on actual expenditures where figures were available or budget allocations where such figures were not available. 4Relative investments of RMP resources in local 50ne description of RMP "Convening/Facilitating" administration and in four major program areas functions is provided in an A. D. Little report, "Evaluation (e.g., primary care, regionalization) are described of Facilitation in the Regional Medical Program," May, in Section 1. 1973. DEMONSTRATION PROJECTS: JOINT FUNDING AND CONTINUATION Additional RMP dollars ("indirect Extensive community involvement Joint Funding costs") are awarded to RMP grantees frequently [ends two unique strengths Since July 1, 1971, RMPs have to support administrative expenses of to RMP initiated projects: initiated and supported 1936 major operating in conformance with Federal (1) dollarcosts of projects are shared demonstration projects. guidelines. Indirect costs are by other organizations, allowing an Demonstration projects result from reimbursed by DHEW to grantees on enhanced level of operation; and (2) extensive but relatively rapid local the basis of negotiated rates; RMPs worthwhile project activities are development and review; they are have no direct control over indirect continued through other financing developed in response to community costs. For the 49 RMPS, grantee mechanisms after RMP funding is needs which are objectively verifiable. indirect costs were $7 million in Federal completed, allowing reinvestment of One indication of community Fiscal Year 1973 and $4.2 million in scarce RMP funds in other needed commitment and participation in RMP 1974, health services improvements. demonstration projects is the number of other health orgainzations and agencies participating as co-sponsors and co-funders of projects. Joint funding serves not only to secure active involvement and financial commitment of the other agencies to FIGURE 6 RMP projects, but also allows an TOTAL INVESTMENT IN RMP enhanced project operation during the INITIATED PROJECTS - RMP AND time of RMP support. Joint funding NON-RMP FUNDING often insures continuation of the (1 936 Projects Since July 1, 1971 projectafter RMP funding support is (49 RMPS) discontinued. Since July 1, 1971, the 49 RMPs developed a total of $52.8 million of joint funding support for RMP initiated projects. Amounts of support by various joint funding sources are summarized in Figure 6. TOTAL RMPFUNDS $109.8 Million Participation by other agencies and organizations in sharing the dollar costs of RMP projects is substantial. Of the 1936 major demonstration projects initiated by RM Ps since July 1, 1971, a total of 1 126 projects were characterized by participation of one, Figure 7 shows the total number of two, or as many as four other sponsors which, singly or in concert, community agencies. co-funded RMP projects. FIGURE 7 DISTRIBUTION OF JOINT FUNDING SOURCES OF RMP INITIATED PROJECTS (Since July 1, 1971) (49 RMPS) NUMBER OF RMP PROJECTS WITH ONE, TWO, THREE OR MORE JOINT FUNDING SOURCES ONE NON-RMP FUNDING SOURCE (739 Projects) TWO NON-RMP FUNDING SOURCES (231 Projects) THREE NON-RMP FUNDING SOURCES (91 Projects) FOUR NON-RMP FUNDING SOURCES (65 Projects) The 1126 projects had a total of 1734 agencies which co-funded the projects with RMP. Figure 8 shows both the numbers of $52.8 Million co-funded RMP projects and the sources of funds used by the co-sponsoring agencies. FIGURE 8 RMP PROJECT FUNDING Pdvate BYTYPEOFJOINT $15.6 M FUNDING SOURCE (496 Projects) (Since July 1, 1971) (49 RMPS) 29% Continuation ". . . to be maximally effective Over the past three years, RMP requires that most RMP supported funding was terminated for 1732 endeavors make adequate provisions demonstration projects, of which 557 for continuation support once initial were originally planned as "one-time" Regional Medical Programs grant activities. Nine hundred seventy-four, support is terminated; that is, there or over 83 per cent, of the remaining generally must be assurance that 1 1 75 projects initiated with the help of future operating costs can be absorbed RMP funds, were continued with other within the regular health care financing funds following termination of RMP system within a reasonable and agreed support. upon period." RMP Mission Statement of June, 1971. The willingness of other agencies and organizations to invest their own funds to continue services when RMP financial support has been completed is an important, concrete measure of the long-term worth of newly developed, expanded, or improved health services. As in the development of joint funding resources, the RMP record in this regard is impressive. FIGURE 9 1732 PROJECTS NUMBER OF DEMONSTRATION PROJECT RMP SUPPORT TERMINATED 175 RMP Projects (Since July 1, 1971) 68% Planned as "one-time" projects FIGURE 1 0 NUMBER OF DEMONSTRATION PROJECTS: CONTINUATION SUPPORTSOUGHTAND OBTAINED (Since July 1, 1971) 1175 PROJECTS Continuation Support 974 RMP Projects Obtained 83% ntinuation ppo.rt Not Obtained 7 Figure 1 1 summarizes the number of single or multiple sources of one year continuation funding of projects. FIGURE 1 1 NUMBER OF SOURCES PROVIDING CONTINUATION FUNDS FOR RMP TERMINATED PROJECTS (Since July 1, 1971) NUMBER SOURCES OF CONTINUATION FUNDS 0 ONESOURCE NON-RMP FUNDS (661 RMP Projects) TWO SOURCES NON-RMP FUNDS (222 RMP Projects) THREESOURCES NON-RMP FUNDS (59 RMP Projects) 0 0 0 FOUR SOURCES NON-RMP FUNDS (32 RMP Projects) The 974 Projects had a total of 1400 sources of funding. In a real sense, local communities FIGURE 12 and agencies have frequently "voted" RMP PROJECTS AFTER RMP FINANCING COMPLETED: with their dollarsforthe maintenance Of FIRST YEAR CONTINUATION FUNDING AMOUNTS worthwhile activities of RMP initiated AND SOURCES $58.5 MILLION projects. Continuation funds are (974 Projects Since supplied by State and local July 1, 1971) governments, other Federal agencies or programs, and private sources, including fee-for-services reimbursements by insurance companies and individuals. Approximately one-third of the 974 Figure 12 summa $17.7 projects continued after termination of the relative dollar 30% RMP funding involved several from sponsoring sources for on sources of support. year continuation funding of projects. 18 The success of RMPs in developing Establishment of New Health ... an RMP in the South Central continuation support for improved Services includesoccasionswherethe United States supported the services initiated as demonstration arrangements ororganizations created development of six health planning projects is due in part to the efforts of resulted in the provision of health agencies with dollars, staff and local RMP program staffs in planning services not previously available on a facilitating efforts; all six are currently for, and specifically building into continuing, permanent basis; e.g., rural approved CHIP (b) agencies. Four projects those features that increase health stations, neighborhood health other CHIP agencies are currently in the likelihood of continuation support. centers, health screening stations, advanced stages of development and In addition to rebudgeting surplus out-patient clinics, pre-paid health will complete comprehensive health project funds as a result of effective service plans. planning coverage of the entire state. fiscal monitoring, limiting the period of Specific examples include: ... RMPs in the Pacific Northwest the RMP support, (usually to a ... a Northeast RMP has established and in the South acted in primary maximum of three years) enables local 6 new ambulatory outpatient clinics in a leadership roles to create statewide Regional Advisory Groups to reinvest medically underserved metropolitan consortia of private and public health available funds to accelerate area where the population per square interests to implement coordinated, development of other activities and mile is almost 50,000 people; nearly statewide comprehensive cancer projects needed to improve local health 45,713 patient visits have been control programs. services for people. recorded since the first unit was Formalization of Sharing of NEW HEALTH ORGANIZATIONS opened on November 7,1972. As a Existing Resources includes AND FORMAL COOPERATIVE direct result of these ambulatory occasions when two or more local ARRANGEMENTS clinics, utilization of hospital health care facilities formalize Creation of needed new health emergency rooms as the place of agreements to jointly support staff or organizations or formal cooperative primary care has decreased by fifty per related services, common purchasing arrangements is a frequent outcome of cent. and billing arrangements, or RMP demonstration projects or ... a medically underserved area, regionalization of specialized health technical assistance processes. which has onlyeight physicians services. The RMPs (47) reported a total of serving a population of almost 19,000 ... a Midwest RMP fostered the over 6,000 occasions since July 1 1 was given a boost by awestern RMP in development of ten distinct 1971, where demonstration projects or establishing a clinic, the Centro de "Cooperative Resource Sharing substantial assistance resulted in the Salud, which has served 2,400 people Groups" primarily to cooperate in the creation of "new health organizations" since its August, 1973, opening; provision of in-service education or "new formal cooperative ... another Western RMP supported programs. Sixty-eight institutions, arrangements" between elements in training and placement of 13 family comprised of 60 of the state's 1 1 0 local health services sytems. nurse practitioners who have served hospitals and 8 nursing homes, are New health organizations include 91 00 isolated rural patients since currently participating in the program. currentlycontinuing clinics, rural health completing training. The estimated savings due to sharing stations, medical care foundations, New Health Organizations of audio-visual resources and areawide planning agencies and Created includes creation of new local in-service instruction time amounts to expansion of services to underserved organizations and cooperative $171,200. In addition, spin-off s due to areas. New formal cooperative arrangements for health planning, this cooperative effort have had a arrangements include additional manpower,andheat service unifying effect on other areas including needed health manpower training development. Examples include shared purchasing, services and programs, shared services "area-wide comprehensive health personnel. agreements and similar cooperative planning agencies", Experimental efforts to achieve greater eff iciency of Heialth Service and Delivery Systems, local health care systems. manpower training consortia, and Majoroccasions in which substantial quality assurance organizations. RMP assistance was provided to create new health organizations or cooperative arrangements at the local level are described below. ... an RMP in the ... an RMP in the West created a Northeast developed agreements statewide corporation representing all among 23 of 50 hospitals in the Region health professions to provide needed to support a coordinated tumor registry continuing education on a for an investment of $184,975 (through self-supporting basis. Since its December of 1973) and modest creation, the organization has provided amounts of staff time. The goal of this planned continuing education project is to serve cancer patients by experiences for over 9000 health stimulating continuity of care and to professionals who are essentially promote continuing physician isolated from large medical centers or education and train medical records other resources for assistance in personnel in a specialized form of maintaining current competence and record keeping to improve patient developing new skills. followup. ... an RMP in New England was Establishment of New Training instrumental in creating and guiding Programs includes assistance to the development of a statewide educational institutions, health manpower training consortium. Since organizations and facilities in the its inception, the consortium has development of new health manpower installed 3 needed "mid-level" training programs needed and practitioner training programs, supported financially at the local level. graduated 60 needed health professionals, and moved effectively toward the establishment of a continuing university-based, integrated training effort of these types of personnel. Figure 13 summarizes the occasions that RMPs provided substantial FIGURE 13 assistance to local communities in creating new health services or NEW ORGANIZATIONS OR FORMAL supportive organizations and formal COOPERATIVE ARRANGEMENTS CREATE cooperative arrangements described RMP TECHNICAL ASSISTANCE OCCASIONS above. (Since July 1, 1971) (47 RMPS) Number of Occasions 1830 1676 NEW HEALTH ORGANIZA- TIONS 1305 984 RMPs described several specific methods and activities used in providing assistance in creating new organizations and formal agreements. Included are: - Provision of direct RMP financial assistance; -Assistance in securing non-RMP financial support; - Assistance by' 'loaning" or "detailing" RMP program staff for a short period of time; - Provision of specialized staff technical expertise and/or external consultants; The numbers of occasions RMPs - Assuming leadership in providing used these specific methods while the initiative to convene interested and assisting in the creation of four kinds of necessary principals. new health organizations and - Securing the cooperation and cooperative arrangements are support of others. summarized in Table XIV. TABLE XIV USE OF TYPES OF RMP ASSISTANCE IN CREATING NEW HEALTH ORGANIZATIONS & FORMAL COOPERATIVE ARRANGEMENTS (Since July 1, 1971) (47 RMPS) Totals 5713 3282 3024 1827 1105 43 851 21 RMPs assisted a wide array of local agencies and professional associations in joint efforts to develop new health organizations, services and agreements. The number of occasions other local agencies received substantial assistance in developing such resources are summarized in Table xv, TABLEXV OCCASIONS OF TECHNICAL ASSISTANCE PROVIDED OTHER AGENCIES IN DEVELOPING NEW ORGANIZATIONS AND FORMAL ARRANGEMENTS (Since July 1, 1971) (47 RMPS) Ne w@ AGENCIESASSISTED New Health Sharinq Training Totals Organizations Resources Programs State and Local Medical Societies 306 109 178@@ 871 Other Professional Associations 246 137 842 Volunteer Health Associations 238 287 1048 State and Local Health Departments 306 403 1457 Comprehensive Health Planning Agencies (A and b) 308 151 907 Educational Institutions 370 261 1474 All Others 371 852 2191 DEVELOPMENT OF RESOURCES RM Ps provided substantial technical Application requests totaled over FOR LOCAL SERVICES assistance in preparation of $368 million, a sum whose magnitude IMPROVEMENTS applications for non-RMP funds to ais indicative of a major development Another major outgrowth of RMPs' wide array of local agencies and effort. Figure 14 summarizes the community-based process has organizations. From July 1, 1971, to amounts requested from each sometimes been described as a January, 1974, the RMPs assisted non-RMP funding source. "broker" role. RMPs'carefully local agencies and organizations in constructed, effective working preparing atotal of 1,135 applications relationships with major segments of for funds for health services the private and public sectors provide aimprovements from (non-RMP) basis of confidence which underlies Federal, State, local and private numerous requests for technical funding sources. assistance to develop applications for funds to support implementation of TOTAL $169.9 Million locally appropriate improvements in health care services systems. FIGURE 14 Local $3.2 M TOTAL DOLLAR REQUESTS AND SOURCES state $35.3 M RMP Assisted Applications for Non-RMP Support (49 RMPS) TOTAL $109.8 Million TOTAL $88.7 Million Loal Local $ .8 M - Federal $76.5 M Federal $77.7 M Federal $113.2 M FISCAL YEAR 1972 FISCAL YEAR 1973 FISCAL YE AR 1974 One indirect measure of the worth of RMP technical assistance is the dollar amount of the non-RMP awards actually made to local agencies and organizations assisted in the preparation of applications. Figure 15 is a summary of the total dollars in non-RMP awards received by local health organizations in cases when RMPs provided substantial technical assistance in developing the application. TOTAL $116.5 Million FIGURE 15 TOTAL DOLLARS RECEIVED AND SOURCES: Local$3 M RMP Assisted Applications for Non-RMP Support (49 RM Ps) Stai TOTAL $65.2 Million Local $2.8 M TOTAL $47.2 Million Local$ 9M- Federal $36.5 M Federal $40.4 M Federal $70.7 M FISCAL YEAR 1972 FISCAL YEAR 1973 FISCAL YEAR 1974 While the specific purposes for (2) The Federalperspective: The which non-RMP funding was sought necessity has been reduced have not been enumerated, in many significantly for creating new cases, applications were for funds to bureaucracies to implement new support continuation of RMP projects programs in a locally acceptable and or for the creation of new local health valid manner. care services organizations or formal (3) The RMP perspective: Provision cooperative agreements previously of technical assistance to develop described. applications for other agencies insures Total dollar volume of applications the continuation of RMP initiated does not, in itself, adequately describe improvements, enhances RMP RMP assisted improvements in local program operations through health care services or the RMPs coordinated community efforts and community development role. establishes a mechanism for However, inferences about the dollar maintaining effective working volume may be drawn from three relationships with the widest array of perspectives: local health interests. (1) The community perspective: RMPs have provided substantial assistance in effective project planning and review, and have successfully played a major role in developing needed additional fincancial resources for local health improvements. COMMENT In addition to improving services to people the RMPs have developed a community-based process which is an effectively functioning model of a federally supported, largely locally controlled implementing agency which has major impact on local health care services systems. The RMPs remain a major National resource capable of prudently and effectively assisting local communities to implement expanded health services for people. COORDINATORS' EXECUTIVE COMMITTEE Donal R. Sparkman, M.D., Chairman Arthur E. Rikli, M.D. Washington/Alaska RMP Missouri RMP Morton C. Creditor, M.D. Mr. Robert Murphy Illinois RMP Tri-State RMP Robert W. Brown, M.D. Mr. Paul D. Ward Kansas RMP California RMP J@ S. Reinschmidt, M.D. John R. F. Ingall, M.D. Oregon RMP Lakes Area RMP Granville W. Larimore, M.D. J. Gordon Barrow, M.D. Florida RMP Georgia RMP Manu Chafterjee, M.D. Mr. Robert Youngerman Maine RMP Southeast RMPs PAR GROUP COUNCIL C. E. Smith, Ph.D., Chairman Gordon Engebretson, Ph.D. Mountain States RMP Southeast RMPs Florida RMP John D. Cambareri, Ph.D. Project Administrator Charles H. White, Ph.D. Mountain States RMP Western RMPs California RMP Mr. Harry Auerbach North Central RMPs John A. Mitchell, M.D. -ex officio Illinois RMP California RMP Chairman, Ad Hoc Evaluation Committee Mr. Robert Miller Northeast RMPs J. Gordon Barrow, M.D. -ex officio Lakes Area RMP Georgia RMP Chairman, Government Information Committee Mr. Roger Warner South Central RMPs Donal R. Sparkman, M.D. Arkansas RMP Washington/Alaska RMP Mr. Roland Peterson - ex officio Chairman, Executive Committee DRMP Rockville, Maryland I I I